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P6 acupressure can help patients self-manage chemotherapy-induced nausea: as seen in the oncology nursing forum.

Chemotherapy-induced nausea (CIN) is one of the most distressing side effects that patients report. Studies have shown highly emetogenic chemotherapy to cause acute nausea in about 71% of patients and delayed nausea in about 60%, even when routine anti-emetics are used. Even with the newest and most effective antiemetics, CIN still remains a significant problem, reducing those numbers only to about 29% and 47%, respectively. Plus, the newest antiemetic agents can be expensive. Research continues to look for more cost-effective ways to manage CIN with fewer adverse effects.

Integrative therapies such as acupressure may be an effective alternative. In their article in the November 2010 Oncology Nursing Forum, Lee et al. studied the effectiveness of acupressure for CIN and the relationship of CIN to frequency of acupressure use.

Acupressure for Nausea

Acupressure is a form of integrative or complementary medicine, meaning that it can be used in conjunction with traditional cancer therapies to help manage the disease or its side effects. Based in the theory of acupuncture, acupressure uses the same points and meridians as acupuncture but with the application of pressure instead of fine needles. Acupressure is very cost-effective as a treatment because no special tools are required, and patients often can be instructed in self-use for managing symptoms at home. Also, acupressure is not associated with side effects the way that some drugs and medications are.

The pericardium 6 (P6) acupressure/acupuncture point has been used for centuries to control nausea. The point is located bilaterally on the anterior surface of the forearm, approximately three finger widths up from the first wrist crease and between the tendons of the flexor carpi radialis and palmarus longus (see Figure 1). One quasiexperimental and several randomized studies have shown P6 acupressure to be an effective way to control CIN (see Lee et al. for a full list of the studies), and the ONS Putting Evidence Into Practice resources for managing CIN and vomiting ( have classified acupressure/ acupuncture as an intervention that's "likely to be effective." In these studies, patients applied pressure to the P6 point (see Figure 2) for three to five minutes, one to three times a day for at least five days over one cycle of chemotherapy, with additional use as needed for breakthrough nausea.



Lee et al.'s study was a secondary analysis of data from a multicenter, longitudinal, randomized clinical trial comparing P6 digital acupressure, placebo digital acupressure, and usual care in women undergoing chemotherapy for breast cancer. Participants applied P6 digital acupressure for three minutes on both arms each morning and an additional three minutes on one arm during the day as needed. The parent study found that P6 digital acupressure was effective in controlling delayed CIN and delayed vomiting.

Relationship of CIN Intensity to Acupressure Use

Lee et al.'s study looked at the group of women who had been randomized to use P6 digital acupressure in the parent study. All of the women were also prescribed and used usual antiemetics. The intent was to determine whether the intensity of the women's CIN was related to the frequency of their use of acupressure.

Lee et al. monitored the women's acupressure use over the 11 days following chemotherapy, during which time all of the women who provided daily records of CIN intensity experienced at least some level of nausea. On average, the women's nausea increased from days 1-3 and then began to decrease. Women experienced nausea through day 7, on average, and stopped having the symptom after that. The women used acupressure an average of twice per day over the 11 days of tracking. The highest amount of use was recorded on day 3, when 12 of the participants used it more than five times, 16 used it three to four times, 10 used it one to two times, and four did not use it at all.

As the researchers expected, the women who had more intense acute CIN used acupressure more frequently on day 1. Women whose nausea intensity started higher from the acute phase continued to experience higher symptom intensity during the 11 days after chemotherapy administration and required more frequent acupressure even after the peak of nausea. When Lee et al. analyzed patient demographic and history data, patient age was found to be the only significant predisposing factor for nausea intensity, with younger age associated with higher intensity.

What This Means for Acupressure Use

Although the results need to be replicated in additional, larger studies that control for antiemetic use, they do provide insight into acupressure use for CIN. First, the study demonstrated that patients are able to use acupressure themselves after initial instruction and that using P6 digital acupressure an average of twice per day for 11 days provides improved CIN control. Lee et al. found that on average, the women used acupressure for one more day after they stopped taking antiemetics, which demonstrates acupressure's efficacy in delayed CIN.

For more information about acupressure's relationship to CIN and CIN intensity, refer to the article by Lee et al.

Lee, J., Dibble, S., Dodd, M., Abrams, D., & Burns, B. (in press). The relationship of chemotherapyinduced nausea to the frequency of P6 digital acupressure. Oncology Nursing Forum.

Key Definitions

Acute nausea: nausea that occurs within 24 hours after chemotherapy is administered

Delayed nausea: nausea that begins and persists more than 16-24 hours after chemotherapy administration

[By Elisa Becze, BA, ELS, ONS Staff Writer]
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Author:Becze, Elisa
Publication:ONS Connect
Geographic Code:1USA
Date:Nov 1, 2010
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